|
PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 99359
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
|
|
PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 99358
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
|
|
PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY
|
Professional
|
Both
|
$2,772.00
|
|
|
Service Code
|
HCPCS 33960
|
| Min. Negotiated Rate |
$1,108.80 |
| Max. Negotiated Rate |
$1,801.80 |
| Rate for Payer: Aetna Medicare |
$1,386.00
|
| Rate for Payer: BCBS Complete |
$1,108.80
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,801.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,801.80
|
|
|
PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 99418
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
|
|
PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99417
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 99356
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Medicare |
$151.50
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
|
|
PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99357
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 99354
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$151.45 |
| Rate for Payer: Aetna Medicare |
$116.50
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
|
|
PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99355
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
|
|
PR PROLONG INPT EVAL ADD15 M
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS G0316
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$53.48 |
| Rate for Payer: Aetna Commercial |
$38.74
|
| Rate for Payer: Aetna Medicare |
$30.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.74
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS MAPPO |
$28.91
|
| Rate for Payer: BCN Medicare Advantage |
$28.91
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Cofinity Commercial |
$41.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.91
|
| Rate for Payer: Healthscope Commercial |
$53.48
|
| Rate for Payer: Healthscope Commercial |
$46.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.95
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: PACE SWMI |
$28.91
|
| Rate for Payer: PHP Medicare Advantage |
$28.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health Medicare |
$28.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.91
|
| Rate for Payer: UHC Medicare Advantage |
$28.91
|
|
|
PR PROLONG OUTPT/OFFICE VIS
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS G2212
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.04 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$54.04
|
| Rate for Payer: Healthscope Commercial |
$46.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Nomi Health Commercial |
$35.05
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.21
|
| Rate for Payer: UHC Medicare Advantage |
$29.21
|
|
|
PR PROMETHAZINE HCL INJECTION
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J2550
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Medicare |
$3.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$2.95
|
| Rate for Payer: BCN Medicare Advantage |
$2.95
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.25
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Healthscope Commercial |
$5.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PACE SWMI |
$2.95
|
| Rate for Payer: PHP Medicare Advantage |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.95
|
| Rate for Payer: UHC Medicare Advantage |
$2.95
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR
|
Professional
|
Both
|
$2,782.00
|
|
|
Service Code
|
HCPCS 27495
|
| Min. Negotiated Rate |
$1,088.89 |
| Max. Negotiated Rate |
$2,014.45 |
| Rate for Payer: Aetna Commercial |
$1,459.11
|
| Rate for Payer: Aetna Medicare |
$1,132.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,459.11
|
| Rate for Payer: BCBS Complete |
$1,112.80
|
| Rate for Payer: BCBS MAPPO |
$1,088.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,088.89
|
| Rate for Payer: Cash Price |
$2,225.60
|
| Rate for Payer: Cash Price |
$2,225.60
|
| Rate for Payer: Cofinity Commercial |
$1,568.00
|
| Rate for Payer: Cofinity Commercial |
$1,459.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,088.89
|
| Rate for Payer: Healthscope Commercial |
$2,014.45
|
| Rate for Payer: Healthscope Commercial |
$1,742.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,143.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.30
|
| Rate for Payer: Nomi Health Commercial |
$1,306.67
|
| Rate for Payer: PACE SWMI |
$1,088.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,088.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,808.30
|
| Rate for Payer: Priority Health Medicare |
$1,088.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,088.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,088.89
|
|
|
PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA
|
Professional
|
Both
|
$2,148.00
|
|
|
Service Code
|
HCPCS 27745
|
| Min. Negotiated Rate |
$707.39 |
| Max. Negotiated Rate |
$1,396.20 |
| Rate for Payer: Aetna Commercial |
$947.90
|
| Rate for Payer: Aetna Medicare |
$735.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,018.64
|
| Rate for Payer: BCBS Complete |
$859.20
|
| Rate for Payer: BCBS MAPPO |
$707.39
|
| Rate for Payer: BCN Medicare Advantage |
$707.39
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cash Price |
$1,718.40
|
| Rate for Payer: Cofinity Commercial |
$947.90
|
| Rate for Payer: Cofinity Commercial |
$1,018.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.39
|
| Rate for Payer: Healthscope Commercial |
$1,131.82
|
| Rate for Payer: Healthscope Commercial |
$1,308.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$742.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,396.20
|
| Rate for Payer: Nomi Health Commercial |
$848.87
|
| Rate for Payer: PACE SWMI |
$707.39
|
| Rate for Payer: PHP Medicare Advantage |
$707.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.20
|
| Rate for Payer: Priority Health Medicare |
$707.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.39
|
| Rate for Payer: UHC Medicare Advantage |
$707.39
|
|
|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$2,041.00
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$816.40 |
| Max. Negotiated Rate |
$1,777.28 |
| Rate for Payer: Aetna Commercial |
$1,287.32
|
| Rate for Payer: Aetna Medicare |
$999.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,287.32
|
| Rate for Payer: BCBS Complete |
$816.40
|
| Rate for Payer: BCBS MAPPO |
$960.69
|
| Rate for Payer: BCN Medicare Advantage |
$960.69
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cofinity Commercial |
$1,383.39
|
| Rate for Payer: Cofinity Commercial |
$1,287.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$960.69
|
| Rate for Payer: Healthscope Commercial |
$1,777.28
|
| Rate for Payer: Healthscope Commercial |
$1,537.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,008.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.65
|
| Rate for Payer: Nomi Health Commercial |
$1,152.83
|
| Rate for Payer: PACE SWMI |
$960.69
|
| Rate for Payer: PHP Medicare Advantage |
$960.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health Medicare |
$960.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$960.69
|
| Rate for Payer: UHC Medicare Advantage |
$960.69
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$2,582.00
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$833.94 |
| Max. Negotiated Rate |
$1,678.30 |
| Rate for Payer: Aetna Commercial |
$1,117.48
|
| Rate for Payer: Aetna Medicare |
$867.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,200.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.48
|
| Rate for Payer: BCBS Complete |
$1,032.80
|
| Rate for Payer: BCBS MAPPO |
$833.94
|
| Rate for Payer: BCN Medicare Advantage |
$833.94
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cash Price |
$2,065.60
|
| Rate for Payer: Cofinity Commercial |
$1,200.87
|
| Rate for Payer: Cofinity Commercial |
$1,117.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$833.94
|
| Rate for Payer: Healthscope Commercial |
$1,334.30
|
| Rate for Payer: Healthscope Commercial |
$1,542.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,678.30
|
| Rate for Payer: Nomi Health Commercial |
$1,000.73
|
| Rate for Payer: PACE SWMI |
$833.94
|
| Rate for Payer: PHP Medicare Advantage |
$833.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.30
|
| Rate for Payer: Priority Health Medicare |
$833.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$833.94
|
| Rate for Payer: UHC Medicare Advantage |
$833.94
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$836.00 |
| Max. Negotiated Rate |
$1,813.59 |
| Rate for Payer: Aetna Commercial |
$1,313.63
|
| Rate for Payer: Aetna Medicare |
$1,019.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,411.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.63
|
| Rate for Payer: BCBS Complete |
$836.00
|
| Rate for Payer: BCBS MAPPO |
$980.32
|
| Rate for Payer: BCN Medicare Advantage |
$980.32
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cash Price |
$1,672.00
|
| Rate for Payer: Cofinity Commercial |
$1,411.66
|
| Rate for Payer: Cofinity Commercial |
$1,313.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.32
|
| Rate for Payer: Healthscope Commercial |
$1,813.59
|
| Rate for Payer: Healthscope Commercial |
$1,568.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,029.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,358.50
|
| Rate for Payer: Nomi Health Commercial |
$1,176.38
|
| Rate for Payer: PACE SWMI |
$980.32
|
| Rate for Payer: PHP Medicare Advantage |
$980.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,358.50
|
| Rate for Payer: Priority Health Medicare |
$980.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$980.32
|
| Rate for Payer: UHC Medicare Advantage |
$980.32
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS
|
Professional
|
Both
|
$2,251.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$695.73 |
| Max. Negotiated Rate |
$1,463.15 |
| Rate for Payer: Aetna Commercial |
$932.28
|
| Rate for Payer: Aetna Medicare |
$723.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.85
|
| Rate for Payer: BCBS Complete |
$900.40
|
| Rate for Payer: BCBS MAPPO |
$695.73
|
| Rate for Payer: BCN Medicare Advantage |
$695.73
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cofinity Commercial |
$932.28
|
| Rate for Payer: Cofinity Commercial |
$1,001.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.73
|
| Rate for Payer: Healthscope Commercial |
$1,113.17
|
| Rate for Payer: Healthscope Commercial |
$1,287.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,463.15
|
| Rate for Payer: Nomi Health Commercial |
$834.88
|
| Rate for Payer: PACE SWMI |
$695.73
|
| Rate for Payer: PHP Medicare Advantage |
$695.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.15
|
| Rate for Payer: Priority Health Medicare |
$695.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.73
|
| Rate for Payer: UHC Medicare Advantage |
$695.73
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.75
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,657.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$1,462.80 |
| Max. Negotiated Rate |
$3,102.65 |
| Rate for Payer: Aetna Commercial |
$2,247.33
|
| Rate for Payer: Aetna Medicare |
$1,744.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,415.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,247.33
|
| Rate for Payer: BCBS Complete |
$1,462.80
|
| Rate for Payer: BCBS MAPPO |
$1,677.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,677.11
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cofinity Commercial |
$2,415.04
|
| Rate for Payer: Cofinity Commercial |
$2,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,677.11
|
| Rate for Payer: Healthscope Commercial |
$2,683.38
|
| Rate for Payer: Healthscope Commercial |
$3,102.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,760.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,377.05
|
| Rate for Payer: Nomi Health Commercial |
$2,012.53
|
| Rate for Payer: PACE SWMI |
$1,677.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,677.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,377.05
|
| Rate for Payer: Priority Health Medicare |
$1,677.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,677.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,677.11
|
|
|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$821.66 |
| Max. Negotiated Rate |
$2,171.65 |
| Rate for Payer: Aetna Commercial |
$1,101.02
|
| Rate for Payer: Aetna Medicare |
$854.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,183.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.02
|
| Rate for Payer: BCBS Complete |
$1,336.40
|
| Rate for Payer: BCBS MAPPO |
$821.66
|
| Rate for Payer: BCN Medicare Advantage |
$821.66
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,101.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.66
|
| Rate for Payer: Healthscope Commercial |
$1,520.07
|
| Rate for Payer: Healthscope Commercial |
$1,314.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,171.65
|
| Rate for Payer: Nomi Health Commercial |
$985.99
|
| Rate for Payer: PACE SWMI |
$821.66
|
| Rate for Payer: PHP Medicare Advantage |
$821.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health Medicare |
$821.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.66
|
| Rate for Payer: UHC Medicare Advantage |
$821.66
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$2,066.30 |
| Rate for Payer: Aetna Commercial |
$1,496.67
|
| Rate for Payer: Aetna Medicare |
$1,161.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,496.67
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: BCBS MAPPO |
$1,116.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.92
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,608.36
|
| Rate for Payer: Cofinity Commercial |
$1,496.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.92
|
| Rate for Payer: Healthscope Commercial |
$1,787.07
|
| Rate for Payer: Healthscope Commercial |
$2,066.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.95
|
| Rate for Payer: Nomi Health Commercial |
$1,340.30
|
| Rate for Payer: PACE SWMI |
$1,116.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health Medicare |
$1,116.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.92
|
|
|
PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES
|
Professional
|
Both
|
$3,269.00
|
|
|
Service Code
|
HCPCS 55821
|
| Min. Negotiated Rate |
$801.00 |
| Max. Negotiated Rate |
$2,124.85 |
| Rate for Payer: Aetna Commercial |
$1,073.34
|
| Rate for Payer: Aetna Medicare |
$833.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.34
|
| Rate for Payer: BCBS Complete |
$1,307.60
|
| Rate for Payer: BCBS MAPPO |
$801.00
|
| Rate for Payer: BCN Medicare Advantage |
$801.00
|
| Rate for Payer: Cash Price |
$2,615.20
|
| Rate for Payer: Cash Price |
$2,615.20
|
| Rate for Payer: Cofinity Commercial |
$1,153.44
|
| Rate for Payer: Cofinity Commercial |
$1,073.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.00
|
| Rate for Payer: Healthscope Commercial |
$1,481.85
|
| Rate for Payer: Healthscope Commercial |
$1,281.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,124.85
|
| Rate for Payer: Nomi Health Commercial |
$961.20
|
| Rate for Payer: PACE SWMI |
$801.00
|
| Rate for Payer: PHP Medicare Advantage |
$801.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.85
|
| Rate for Payer: Priority Health Medicare |
$801.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.00
|
| Rate for Payer: UHC Medicare Advantage |
$801.00
|
|
|
PR PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 55700
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$128.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.36
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS MAPPO |
$123.40
|
| Rate for Payer: BCN Medicare Advantage |
$123.40
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$177.70
|
| Rate for Payer: Cofinity Commercial |
$165.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.40
|
| Rate for Payer: Healthscope Commercial |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$228.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.60
|
| Rate for Payer: Nomi Health Commercial |
$148.08
|
| Rate for Payer: PACE SWMI |
$123.40
|
| Rate for Payer: PHP Medicare Advantage |
$123.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.60
|
| Rate for Payer: Priority Health Medicare |
$123.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.40
|
| Rate for Payer: UHC Medicare Advantage |
$123.40
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 55725
|
| Min. Negotiated Rate |
$428.00 |
| Max. Negotiated Rate |
$1,055.17 |
| Rate for Payer: Aetna Commercial |
$764.28
|
| Rate for Payer: Aetna Medicare |
$593.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.28
|
| Rate for Payer: BCBS Complete |
$428.00
|
| Rate for Payer: BCBS MAPPO |
$570.36
|
| Rate for Payer: BCN Medicare Advantage |
$570.36
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$821.32
|
| Rate for Payer: Cofinity Commercial |
$764.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.36
|
| Rate for Payer: Healthscope Commercial |
$912.58
|
| Rate for Payer: Healthscope Commercial |
$1,055.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.50
|
| Rate for Payer: Nomi Health Commercial |
$684.43
|
| Rate for Payer: PACE SWMI |
$570.36
|
| Rate for Payer: PHP Medicare Advantage |
$570.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.50
|
| Rate for Payer: Priority Health Medicare |
$570.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.36
|
| Rate for Payer: UHC Medicare Advantage |
$570.36
|
|
